Healthcare Provider Details

I. General information

NPI: 1922514314
Provider Name (Legal Business Name): PAYAL KOTHARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MILFORD ST
SALISBURY MD
21804-6952
US

IV. Provider business mailing address

101 MILFORD ST
SALISBURY MD
21804-6952
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-9290
  • Fax: 410-543-9087
Mailing address:
  • Phone: 410-749-9290
  • Fax: 410-543-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number008715
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2979
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: